Non-muscle-invasive bladder cancer (NMIBC) is a biologically heterogeneous disease and is one of the most expensive malignancies to treat on a per patient basis. In part, this high cost is attributed to the need for long-term surveillance. We sought to perform an economic analysis of surveillance strategies to elucidate cumulative costs for the management of NMIBC.
A Markov model was constructed to determine the average 5-year costs for the surveillance of patients with NMIBC. Patients were stratified into low, intermediate, and high-risk groups based on the EORTC risk calculator to determine recurrence and progression rates according to each category. The index patient was a compliant 65-year-old male. A total of four health states were utilized in the Markov model: no evidence of disease, recurrence, progression and cystectomy, and death.
Cumulative costs of care over a 5-year period were $52,125 for low-risk, $146,250 for intermediate-risk, and $366,143 for high-risk NMIBC. The primary driver of cost was progression to muscle-invasive disease requiring definitive therapy, contributing to 81% and 92% of overall cost for intermediate- and high-risk disease. Although low-risk tumors have a high likelihood of 5-year recurrence, the overall cost contribution of recurrence was 8%, whereas disease progression accounted for 71%.
Although protracted surveillance cystoscopy contributes to the expenditures associated with NMIBC, progression increases the overall cost of care across all three patient risk groups and most notably for intermediate- and high-risk disease patients.
World journal of urology. 2018 Nov 16 [Epub ahead of print]
Matthew Mossanen, Ye Wang, Julie Szymaniak, Wei Shen Tan, Melissa J Huynh, Mark A Preston, Quoc-Dien Trinh, Guru Sonpavde, Adam S Kibel, Steven L Chang
Division of Urology, Harvard Medical School, Brigham and Women's Hospital, 45 Francis Street, Boston, MA, 02115, USA. ., Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA., Division of Urology, Harvard Medical School, Brigham and Women's Hospital, 45 Francis Street, Boston, MA, 02115, USA., University College of London, London, England, UK., Dana-Farber Cancer Institute, Boston, MA, USA.